From the Shadow of Nyiragongo: A YoungDoctor’s Journey Through Conflict andCare in Eastern CongoI was born and raised in Goma, a city in the eastern Democratic Republic of Congo whoseidentity has long been shaped by both extraordinary natural beauty and persistent instability.Nestled between the shores of Lake Kivu and the majestic Nyiragongo volcano, Goma isbreathtaking at first sight. Yet beneath this remarkable landscape lies another reality: easternCongo has endured recurrent armed conflict for more than three decades. Generations havegrown up amid repeated cycles of violence, displacement, and fragile recovery, leavingprofound consequences for communities, livelihoods, and an already vulnerable healthsystem.Growing up in the shadow of Nyiragongo taught me that uncertainty was part of everydaylife. The volcano itself was a constant presence, sometimes calm, sometimes threatening,always reminding us that life could change without warning. But the greatest uncertaintycame not from nature alone; it came from the recurring insecurity that shaped everyday lifeacross the region.Despite these challenges, I dreamed of becoming a physician. I believed medicine offered away to serve my community and bring hope where suffering often seemed overwhelming.After years of study, I graduated from medical school in October 2023, eager to begin mycareer. Like many newly qualified doctors, I expected my greatest challenges to involverefining my clinical skills, learning from senior colleagues, and gradually building confidenceas an independent physician.Instead, my first year of practice unfolded in a healthcare system already under considerablestrain. Then, towards the end of 2024 and into early 2025, the renewed escalation of armedconflict transformed daily life in Goma. Thousands of families fled their homes, healthfacilities struggled to remain operational, and access to healthcare deteriorated rapidly.Overnight, the medicine I had learned in medical school collided with the realities ofhumanitarian medicine.Hospitals that were already operating with limited resources suddenly faced an influx ofpatients injured by violence while continuing to care for pregnant women, children, patientswith chronic illnesses, and those suffering from infectious diseases. Several peripheral healthcentres suspended activities because of insecurity, disrupting referral networks that manypatients depended upon. Essential medicines, laboratory reagents, blood products, oxygensupplies, and other medical commodities occasionally became scarce, forcing clinicians tomake difficult decisions about patient management.Clinical practice changed dramatically. Diagnostic investigations that would normally guidetreatment were not always available. Laboratory tests were sometimes impossible becausereagents had run out, imaging services were periodically interrupted, and electricity failuresbecame increasingly common. We learned to rely heavily on careful clinical examination,repeated bedside assessment, and close teamwork to make the best decisions possible with thelimited resources available.
Sometimes, the challenge was not deciding what treatment a patient needed; it was decidingwhat could realistically be provided. Patients who would normally require referral to higher-level hospitals could not always be transferred because roads had become unsafe or referralfacilities had already reached capacity. Clinical judgment therefore extended beyond medicinealone; it required weighing the patient’s condition against logistical and security constraintsthat were entirely outside our control.Triage rapidly became one of the most important skills we developed. Some days, patientsarrived faster than beds became available. Emergency departments became overcrowded, andevery decision mattered. Determining who required immediate intervention, who could safelywait, and who needed referral despite uncertain transport conditions demanded balancingclinical urgency with the realities of an overstretched health system.One memory remains particularly vivid. During one especially busy shift, every available bedwas occupied while additional patients continued arriving. Families waited anxiously incorridors, hoping that space would become available. We knew what many critically illpatients needed, yet referrals were sometimes impossible because roads had become unsafe orreferral hospitals had already reached capacity. For a young doctor, confronting thesesituations was emotionally overwhelming. It was the first time I truly understood thatmedicine is not only about curing disease; it is also about remaining present, compassionate,and ethically grounded when ideal care cannot be provided.Power outages introduced additional challenges. Emergency consultations and proceduressometimes continued under flashlights or by the limited electricity supplied by generators.Even simple laboratory analyses could be delayed, forcing us to monitor patients clinicallywhile waiting for essential investigations. Outside, the familiar silhouette of Nyiragongoremained visible against the night sky, a constant reminder of home while everything aroundus seemed increasingly uncertain.Yet amid these enormous challenges, I witnessed extraordinary resilience.Patients demonstrated remarkable courage despite losing homes, livelihoods, and loved ones.Mothers waited patiently for hours with sick children. Families carried injured relatives overlong distances after transportation became impossible. Communities organized themselves tohelp vulnerable neighbours reach healthcare facilities. Even during crisis, hope endured.I was equally inspired by my colleagues. Doctors, nurses, laboratory professionals, cleaners,ambulance drivers, security personnel, and many other support staff routinely worked beyondscheduled hours, often without knowing whether they would be able to return safely to theirfamilies at the end of the day. Fear was rarely expressed openly, yet everyone carried itquietly. Still, they continued caring for patients because they understood that illness does notpause during conflict. Their dedication reinforced my belief that healthcare is ultimately acollective commitment to humanity.These experiences profoundly transformed my understanding of medicine. Before beginningclinical practice, I viewed medicine primarily as the application of scientific knowledge todiagnose and treat disease. Working through a humanitarian crisis taught me that medicinealso demands adaptability, humility, leadership, communication, and ethical decision-makingunder profound uncertainty. I learned that compassion sometimes becomes the most importanttreatment we can offer when resources are insufficient.
Despite the hardships, there were moments that renewed our determination. A critically illpatient recovering against expectations, a child discharged home after days of intensive care,or the simple gratitude expressed by families reminded us that every effort mattered. Thesemoments sustained us through uncertainty and reaffirmed why we had chosen this profession.In September 2025, I left Goma after receiving a scholarship to continue my medical trainingin Mali. Leaving was far more than a geographical transition. I was leaving the city where Ihad grown up, where I had become a physician, and where my first professional experienceshad been shaped by caring for patients during one of the most challenging humanitarian crisesof my generation.Today, as I continue my medical journey in Mali, I often find myself returning mentally tothose early days in Goma. Whenever I face difficult clinical decisions, I remember the lessonslearned there: that effective healthcare depends not only on technology and resources, but alsoon resilience, teamwork, compassion, and the willingness to continue serving others despiteuncertainty.Goma will always be more than my hometown. It is where I discovered that medicine is notdefined solely by scientific knowledge or sophisticated technology. It is defined by people,patients who continue to hope, communities that refuse to give up, and healthcareprofessionals who continue caring for others even when circumstances seem overwhelming.The shadow of Nyiragongo shaped my childhood. Practising medicine during conflict shapedthe physician I am becoming. Those experiences continue to guide me today and strengthenmy commitment to improving healthcare for vulnerable populations wherever my career maylead. I remain hopeful that one day the people of eastern Congo will enjoy the lasting peacethey deserve, allowing future generations of young doctors to begin their careers in hospitalsdefined not by conflict, but by opportunity, dignity, and hope.
By Dott: Rebecca Asifiwe Batezi